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SOS DD

What does it take to become a doctor?  Endurance and perseverance help. It is a long haul from college to practice.  But the skill that is most beneficial is the ability to consume prodigious amounts of information, remember it, and recall it as needed.  Although I often relied on ‘B’ to get me through some of the exams.

Thinking, specifically critical thinking, is not high on the list of abilities that are needed to become or be a doctor. Day to day, doctors need to think clinically, not critically.  Clinical thinking consists of synthesizing the history, the physical and the diagnostic studies and deciding upon a diagnosis and a treatment plan.  It is not as simple as you might think.  When medical students start their clinical rotations and you read their notes, you realize they have what amounts to an advanced degree at Google U.  They know a huge amount of information, but have no idea how the information interrelates and how to  apply the that information to a specific clinical scenario.  With time and experience, and it takes at least a decade, students become clinicians and master how think clinically, but rarely the need to think critically.

The volume of data combined with time constraints ensures that we need to rely on the medical hierarchy to help manage the information overload required to apply science and evidence based therapy.  There is just to much data for one tiny brain to consume. Other doctors rely on me for the diagnosis and treatment of odd infections.  In turn, I  rely on the published knowledge and experience of my colleagues who have devoted a career to one aspect of infectious diseases.  There is little time for most doctors to read all the medical literature carefully, and usually little need.  We have people and institutions  we use as surrogates.

Not only is critical thinking usually not required to be a good physician, but medical practice can conspire to give physicians a false sense of their own abilities.  Really.  Some doctors have an inflated sense of self worth.  Who would have thought it?  Spend time with some doctors and listen to them pontificate on politics or economics with the same (false) assurance that have in their true field of expertise, and you will run screaming from the room.

Medicine is rife with confirmation error. In practice there is rarely negative feedback for making a wrong diagnosis, since everyone is wrong all the time. The good doctors are nimble, changing course quickly rather than sticking to a wrong diagnosis.  And there is no lack of positive feedback from good results.  There is the potential for unbalanced positive feedback to engorge the susceptible ego.  Last week I was walking downtown and was stopped by a lady, daughter of a patient, who introduced me to her friends as “the doctor who saved my mothers life.”  Not really true given that medicine is a team effort, and while I made the diagnosis others had missed, I know if it I had not made the diagnosis, some other ID doctor would have.  Talk about a chance for egoboo.  On the other hand, I must admit to great irritation when the hard work of the ICU team pulls someones bacon out of the fire and the credit goes to god.  I want to yell it was not god that saved your father, it was the doctors and nurses and respiratory therapists and the rest of the hard working, highly experienced ICU staff.  And just why did god make him so ill in the first place?   I do want at least partial credit and remain grateful that mind reading is not a reality.

The other weird thing that happens in medicine is the explicit knowledge we learn in medical school and residency over time becomes implicit.  I have discussed before how sometimes I can come to the correct diagnosis with  minimal information, almost intuition, and then explain after the fact how I came to the diagnosis.  It almost feels like the answer bubbles up from below awareness.   It is most peculiar how much of my medical reasoning occurs below my consciousness.  If  one is not careful that seeming quasi-omniscience could lead to a certain arrogance about your own abilities.  And if part of your job is to hold peoples living hearts in your hand?  It amazes me that the heart surgeons I work with are such nice, self-effacing people.

Add the lack of training in critical thinking to the weird combination of the Peter Principle and Dunning-Kruger Effect and you have a SCAM proponent in the making.  The first says that people rise to their level of incompetence, and if someone masters an area of expertise, they become incompetent in another field.  The latter suggests that “people make poor decisions and reach erroneous conclusions, but their incompetence denies them the metacognitive ability to appreciate their mistakes.”  When good docs go SCAM.

Starting with the basic sciences as a premed and working your way through the Brobdingnagian quantities of information to understand the workings of the human body in health and disease results in knowledge, but not necessarily wisdom;  learning not how to think, but what to think.  You have to trust that those up and down the line of experience know, at least in part, what they are doing: intern to resident to chief resident to attending to subspecialist.  I variously use team sport and hive intelligence to describe the practice of hospital medicine, although the Borg may be a better metaphor.  That being said, there is, at least in my small neck of the woods, little dogmatism.  Skeptics, die hard and otherwise, are often portrayed as close-minded and dogmatic, but in the teaching hospitals I practice in, explanations of the medical  literature are often filled with qualifications and caveats as we teach the residents.  How much of the great grey uncertainty that is medicine is passed on to patients is always an interesting question, and different clinicians will react differently to that clinical challenge.

I rarely see the caveats and uncertainty in the SCAM world that is common in medicine.  Often my answer to a consult is that the patient does not have an infection, or if they do, I have no specific therapy and you have to let the disease run its course. I wonder, in passing, if anyone has ever gone to a SCAM provider and been told: Nope. Sorry. Can’t help you. —Insert magic here— has no benefit for —insert disease here—. I bet almost never.

Patients use SCAMs for a variety of reasons, and I do not pretend to understand why people prefer magic over reality.  And, sounding like the arrogant tool of the medical industrial complex that I am, I wonder if part of the reason is they don’t know any better, and, really, most people have no reason to.  The average person has little motive or inclination to become immersed in the background required to understand why SCAMs are nonsense.  They have better things to do.

But MD’s?  You would think a doctor would know better. Astronomers do not flock to astrology.  Physicist do not push perpetual motion machines in large numbers.  Geologists do not become young Earth creationists in droves. It flabbers my gaster that, after learning all the information required to put MD after your name, anyone could find any validity in any SCAM.  Yet many do, too many.  Part of my assumption is that the Oz’s and Chopra’s and Weil’s of the world do not process information about the world in the same way the Gorski’s and Novella’s and Atwood’s do.  Either they never learned, or cannot learn, critical thinking, or, most importantly, applying the concepts to themselves.

I was originally dragging my feet writing this essay, as the topic was going to be Dr. Oz, who consistently demonstrates all the cognitive flaws and biases mentioned above.  The first thing I did when I received my medical school acceptance letter, besides checking the name to make sure it was really addressed to me and not a mistake,  was sell my electric typewriter, thinking I would never have to type again.  The thought of transcribing his shows filled me with dread, as my typing skills are barely up to the task to transcribing the thoughts in my head, much less the words that flow from Dr. Oz.  Imagine my delight when I came across an editorial in JAMA, Medicine’s Great Divide—The View from the Alternative Side,  by Dr. Chopra, which has the same odd world view and odd thinking with none of the transcription issues.  Cut and paste is so much easier.

The world of Dr. Chopra is radically different from the world in which I live and practice medicine.   My professional world view is equal parts an understanding of objective science and an understanding of the almost too numerous to count human intellectual and physical frailties and short comings that make applying science to patient care difficult and prone to error.  And that doesn’t even include just how hard it is to figure out what is going on in patients.  Of course, people never see themselves as other see them.  When I read Chopra’s account, I also have to ask myself, is my professional world view correct.  Or am I just this guy, you know?  But my Beeblebrox-like internal monologue reassuringly responds no.  Let us go todash.

Conventional medicine is offended that alternative medicine even exists. For the average physician, to hear that an allergy patient is taking extract of nettle to treat his symptoms or that a breast cancer patient is being treated with coffee enemas and a macrobiotic diet arouses scorn. Over a decade ago, when the New England Journal of Medicine reported that Americans pay more visits annually to alternative practitioners than to MDs, the attitude of the editorial writer was barely disguised dismay and disbelief. It was as if the whole country had turned its back on jet travel to return to the horse and buggy.

I do not speak for conventional medicine,  or as I like to call it, medicine, only for myself, but I do have a sense of dismay when  doctors use and promote SCAMs.  Other people?  Not so much.  Dr. Chopra evidently feels that relying on the irrational magics of earlier ages to be a reasonable way to approach health and disease.  It is  worse than horse and buggy, which will at least get you to your destination.  SCAMs are the intellectual equivalent of returning to demon exorcism, cupping, bleeding  and purging to treat and prevent illness. It is applying the principles of Harry Potter in a world where disease and death are real.  In my world view, a bad idea.  On the other hand, in the entire essay, he never once mentions a specific wackaloon SCAM as worthy for use in patient care, preferring to focus on the shortcomings of medicine.

Yet at bottom no one could really object to the aims of alternative medicine, which are to bring relief to the whole patient.

What is that old road to hell paved with? I can’t recall.  Object to the aims? No. Everyone thinks they are acting in a beneficent manner  he writes resisting the urge to be accused of Godwins Law.  The methods?  Well, yeah, I object to the methods,  The objections with SCAMs have nothing to do with aims, Dr. Strawman.  It is with how those aims are accomplished.  I have trouble trusting peoples health and well being with interventions that have no basis in my understanding of reality.

He spends the rest of the paragraph dwelling on the pathologies of  modern medicine: the lack of time and the unpleasant environments of modern hospitals, with the usual implied argument that since medicine has issues, SCAMs must be valid and the solution.

In other words, the other party in the divorce—those who have lost faith in conventional medicine—has its own valid reasons.

Because I am fat,  therefore  you are  thin.  It gets tiresome seeing the same flawed arguments.  Has Dr. Chopra never bothered to peruse the cognitive error or logical fallacies pages on the Wikipedia to at least casually educate himself on the bare minimum of critical thinking?  SCAMs of all stripe have to have to stand or fall on their own merits, not on the perceived and real failings of medicine.  The response of my hospitals to the problems with medicine has not been to abandon medical science in favor of nonsense, but to rigorously apply the results improve on what we have, with remarkable results.  We have made the airplane fly better, safer and more comfortably, not abandoned the airplane in favor of levitation.  Italics mine:

The two camps are not as opposed as they once were. Twenty-five years ago the possible efficacy of traditional healing modalities, herbs, Eastern therapies like acupuncture, and even mind-body medicine was so foreign as to be entirely alien. Today there are still die-hard skeptics (ie people with a consistent understanding of reality who understand that the shortcomings of human cognition apply to themselves as much as to others), of course. But in a mood of expanded tolerance (read easy money), an MD can look at the research on neurotransmitters, cell membrane receptors, and brain physiology, which has made enormous strides in recent decades. Taken as a whole, this research describes the body as an integrated system that exchanges information continuously between the mind, via the brain, and every cell in the body.

What? Huh? Say what?  I can’t see how the first part of the paragraph relates to the second half of the paragraph.  I have to admit, with a child in middle-school, I have been reading my sons five-paragraph essays, with their emphasis on logical flow and coherence, so perhaps I am out of practice with reading essays written by adults and miss the subtle connections between alien modalities and modern neurophysiology.

One aspect of SCAM proponents I note is they like to take obvious conclusions, what should be almost banal statements, and make them seem like they are profound insights into the human condition available only to SCAM proponents, “the body as an integrated system that exchanges information continuously between the mind, via the brain, and every cell in the body.”  Well, duh.

I guess Dr. Chopra hasn’t spent time on rounds in the hospital for a while, where the endless permutations of physiologic interactions and complexity are discussed, observed and modified.  Understanding these interactions is part of what makes the practice of medicine, real medicine,  so damn hard.  It must be so much easier to do some quantum mind-body hand waving and not have to actually fret about the application of practical physiology.

With real-time scans from functional MRIs staring them in the face, MD’s have no reason to look upon the placebo effect, for example, as “not real medicine.” When patients feel relief from chronic pain by being given a sugar pill, the body’s endorphins are filling the same receptor sites in the brain that externally administered opiates fill.

Placebo has always been real medicine, the question is whether using a placebo is ethical (it is not, since lying to a patient is not ethical) and how effective placebo is (for pain, barely efficacious, for any other disease placebo has no effect).  In my world view placebo is wrong, because lying to patients is wrong, its effects are marginal (especially for infections) and I have yet to find a way to use placebo without lying to a patient.

But SCAM practitioners have a key insight that only they have access to: the importance of diet.  Of course he transitions into the old trope that diet is alternative. Alternative to starving I suppose.  As my son would say to me, how edgy. Changing diet can improve cardiovascular disease. <sarcasm>WTF. No one ever told my ever in the last 25 years that diet was important for cardiovascular and other diseases. I want a refund from OHSU.</sarcasm>.  It is important for SCAM practitioners to pretend that diet is somehow alternative, and then by extension, validating real nonsense in fields like reiki or acupuncture or homeopathy.  SOS DD.

Seriously, what offends me is not alternative medicine, but sloppy, inaccurate, lazy thinking, be it in SCAMs, politics or literary criticism.  And so much of SCAM is sloppy thinking, sometimes from educated people who I think should know better.  But I remain of the opinion that sloppy thinkers make sloppy doctors.  Dr. Chopra is a board-certified endocrinologist, and he is trying to imply with a straight face that lifestyle changes, diet and exercise, are not at the core of the approach to type 2 diabetes and cardiovascular disease?  Ground rounds this week was an update on hypertension.  The first part of the lecture?  Diet and exercise.  It is the old truth that if you repeat a lie often enough, people will come to think it true.

One sign of growing reconciliation comes in the form of softened terminology. Instead of calling it alternative or holistic medicine, as I’ve been doing, the more acceptable term is complementary and alternative medicine (CAM), which sends the signal, “See? I am not your foe. We can cooperate. We’re complementary.” Which is true.

It reads like Jake Chambers final essay. You have to watch CAM all the time, CAM is a pain and that is the truth. Really? You can add nothing to something and increase its value?  If the integrative medical centers ever go under, they may have a job on Wall Street. 1 plus 0 is not 2, except in the world of SCAM.  See.  I am your foe.  You offer nothing of value.  Which is true.

Then he shifts to reality mixed with BS. Italics mine:

The problem is that an MD’s practice is badly set up to promote prevention (often true). Visits are too short (yep).  Aren’t adequately trained beyond their specializations (BS). Their habits are focused almost entirely on drugs and surgery as treatment modalities (BS). Prevention is considered too “soft,” (BS) and yet, if you shift the burden of prevention to the patient (lets call it empowerment when the SCAMsters do it) (which most MDs are more than happy to do (lets call it a partnership when the SCAMsters do it)), there is enormous resistance (BS). The public has been given countless warnings about smoking, poor diet, and lack of exercise, yet we have by no means eradicated lung cancer, obesity, coronary artery disease, and type II diabetes (true). Lifestyle disorders prove intractable when people cling to bad lifestyle habits and resist adopting good ones (true, but whose ‘fault’ is that?). We remain a nation of sedentary overeaters, paying pious lip service to prevention while doing less than enough about it (true, but is the solution in SCAM?).
This is where CAM makes significant inroads, because one of its main themes is the return of power to the patient.

See, I told you where this was going.  Doctors dump, CAM returns power to the patient.  I love the language of BS.  The lessons of Animal Farm and 1984 remain relevant in 2011, and probably for the life of the human species.  I imagine that those who seek SCAMs are motivated to see a benefit from a particular SCAM.  SCAM providers see a self-selected population who want to have results from what ever modality they are using.  I would wonder how effective any SCAM based therapy would work if tested on a population of CFI or JREF members. So much potential for confirmation bias in the assertion that SCAMs have a unique ability to alter peoples behavior by empowering the patient.

MDs should welcome the whole trend to self-treatment instead of taking the scornful attitude that nothing works but the modalities taught in medical school.

So when is shifting the burden magically transformed into a trend to self treatment? When it is offered by a SCAM practitioner. Most MDs are aware that medical school is the beginning, not the end, of learning, and also recognize that it is as important to know what isn’t effective is as important as knowing what is effective.  It is why medicine evolves and SCAMS are intellectually stagnant.  Dr. Chopra seems to invent a world that does not exist, at least in Portland, and then rail against it. Trying to engage the patient is their care  has been a goal in medicine for decades.

The real mystery—one that deeply intrigued me 25 years ago—is that so many therapies that totally disagree with one another manage to bring results. Ayurveda isn’t qigong; yoga isn’t Reiki; none of them is a placebo. Yet somehow healing exists, and the channel it takes can be quite unexpected and inexplicable.

The real mystery is that so many forms of astrology totally disagree with another manage to bring results.  No mystery if you live in a reality-based environment.  The real answer, the rational answer, is that none of them do diddley.  People often get better and always have and the ability for people to fool themselves and others is endless.  That paragraph, more than any other in the essay,  sums up the difference I see between SCAM proponents and SBM: a complete lack of insight and critical thinking that allows people to not recognize their own limitations in understanding the world.  Yet I am the closed minded arrogant tool. Sheesh.

Continuing in a vein separate from the world I work in,

The inconvenient truth that “you can heal yourself” has always been the foundation of medicine. The body is the locus of the healing system; physicians assist this complex, little-understood system. They do not actually do the healing. If this feels threatening to MDs, there is much more room for pride to take a fall.

Dude, its not inconvenient at all. We all know that.  No one is threatened.  So many Stuffy Guys, I worry about a tremendous conflagration should nonsense arguements become flammable.  What’s next?  We in SCAM understand that water is wet and fire is hot?  Only SCAM practitioners seem to make it a virtue to trumpet the obvious as if it were some profound truth. Little understood?  What, you give up reading the literature? Understanding of healing is not complete, but it is broad and deep.

Conventional medicine also faces the mysterious “decline effect”—established medications steadily lose their effectiveness over time, as if the newer generation of patients has different, less receptive physiologies.

Is this willful ignorance?  Massive confirmation bias?  Mysterious? Really?  Doesn’t he read and think about these topics? Dr. Steven Novella:

…it is no surprise that effect science in preliminary studies tend to be positive. This can be explained on the basis of experimenter bias — scientists want to find positive results, and initial experiments are often flawed or less than rigorous. It takes time to figure out how to rigorously study a question, and so early studies will tend not to control for all the necessary variables. There is further publication bias in which positive studies tend to be published more than negative studies.
Further, some preliminary research may be based upon chance observations — a false pattern based upon a quirky cluster of events. If these initial observations are used in the preliminary studies, then the statistical fluke will be carried forward. Later studies are then likely to exhibit a regression to the mean, or a return to more statistically likely results (which is exactly why you shouldn’t use initial data when replicating a result, but should use entirely fresh data – a mistake for which astrologers are infamous).

Are SCAMs immune from the decline effect?  Probably, since you can’t decline past zero. Any further decline in the effects of homeopathy or acupuncture or energy therapy would soon cross into increasing the symptoms they are attempting to  treat.

For me, the most distressing aspect of the decline effect is how widely it is being ignored.

Come on rounds, Dr. Chopra.  Listen to our Intensivists discuss the use of steroids in sepsis or the Cardiologist discuss the approach to acute coronary events with the residents.  The history of the literature, why the approach has evolved as the studies have refined and extended our understanding.  The decline effect is an integral part of the teaching of medicine, it is an integral part of the history of science and the evolution medicine.  Just like the complexity and the integrated systems of the body, it is part of the foundation of the practice of medicine, although, like much of the foundations of medicine, rarely explicitly stated, except as a source of pseudo-profundity.

More distressing appears to be the inability to apply the same worry to SCAMs, where the history demonstrated increasingly better studies of SCAMs resulting in decreasing efficacy until well designed, bias free studies show no efficacy. Not a decline effect, but a crash, burn and explode effect, always ignored by the SCAM proponents.  Oh well, a foolish inconsistency is adored by SCAM minds and its philosophizers.  If you think medicine has issues, read the CAM literature.  It is nice how artfully Dr Chopra fails to note that the literature in the SCAM world is several logs worse and almost no intervention has any physical or biological plausibility.

My purpose isn’t to justify the vast universe of healing modalities that exist outside Harvard Medical School (Besides the Palin-esque stab at populist anti-intellectualism, I note that Harvard is long past it’s prime as a medical arbitrator, what with the Osher Clinical Center and all.  Harvard has consumed the Kool-aid). I look instead toward the next phase of this reverse marriage, which is shy courtship. If both sides stopped being defensive, they would see that they share core values: treating the whole patient, reducing suffering, closing the gap between healer and healed, and doing the least harm while bringing the greatest good.

Whoops. Forgot a core value: trusting patients lives and fortunes to therapies that have efficacy based on reality and that are effective. Small thing, I know, but I am old school and feel obligated to treat patients with therapies that are effective beyond the self delusions and biases of the practitioner.

With that in mind, I have little desire to debate with skeptics and scientists who disdain CAM and falsely claim that only their side is valid and evidence-based. The mystery of healing remains unsolved.

Whew. I guess he will not be responding in the comments and prefers to live in his own world.  Like people who only watch Fox news.  This week I helped cure/heal two heart valve infections, a relapsing fever, a malaria and a handful of pneumonias and skin infections.  No mystery there for me.  Do I understand all parts of healing?  Nope.  Does that invalidate the parts I do understand? Nope. Would any SCAM have ‘complemented’ any part of my patients course?  Nope.  I do agree that SCAMs are evidence-based, it is just that the science and evidence demonstrates they do nothing and that science and evidence has validated their worthlessness.

He concludes

The next step will be to remodel medical school curricula so that future physicians are not wandering in the dark as my generation did, totally ignorant, if not blind, about treatments outside our narrow band of knowledge. Expanded medicine is the answer, I am sure of that.

Just as I am sure the world will not be improved by SCAMs modalities.  For fun, let us make a list on the advances in human health made in the last 100 years, in the US or elsewhere, due to application of any SCAM:

 

 

 

 

 

 

 

 

 

 

 

My wife likes to say if you want to predict the future, look at the past.

I do not practice in the world of Dr. Chopra or understand its allure.   His medical world is divorced from the one I work in, and his approach to understanding medicine could be used as a textbook examples on logical fallacies,  cognitive errors, and disingenuous argument.  I am less than impressed. As Dr. Feynman said, “The first principle is that you must not fool yourself, and you are the easiest person to fool.”  Unless you think the future is expanded medicine.

SOS DD: same old stuff, different Doc.  It has other meanings.

Posted in: Energy Medicine, Medical Academia, Nutrition, Science and Medicine

Leave a Comment (65) ↓

65 thoughts on “SOS DD

  1. TsuDhoNimh says:

    And the stock market: If I heard a bunch of doctors thought something was the next ‘hot stock”, I’d think very carefully about selling it short immediately.

  2. windriven says:

    How curious that the esteemed Chopra did not apparently trouble himself to address the large pachyderm in the room: quackery doesn’t work. Medicine, a good deal of the time, does.

    Confronted with his own appendicitis I wonder if Chopra would visit a surgeon or eat peach yogurt and stinging nettles? Faced with an MRSA infection would he seek a pus whisperer or a homeopath? And if he would choose rationally for is own care, on what grounds would he advocate less for others? Is he a sociopath?

  3. weing says:

    There is an old saying that applies here: “False gold exists because of the real.”

  4. “It flabbers my gaster that after learning all the information required to put MD after your name that anyone could find any validity in any SCAM. Yet many, too many, do….Either they never learned, or cannot learn, critical thinking, or, most importantly, applying the concepts to themselves.”

    Or they’re outright charlatans.

  5. CC says:

    “What? Huh? Say what? I can’t see how the first part of the paragraph relates to the second half of the paragraph.”

    The way I read that paragraph was as a claim that the progress of research in neuro and the chemical/physical connection between brain and body was somehow proof that mind-body medicine and things such as a pressure point on your feet affecting your liver function were valid.

    That because there is some kind of a genuine connection found by science (which I don’t understand at all beyond what I’ve read in Scientific American Mind), that all of the CAM “connection” modalities are therefore also valid, and it’s only a matter of time before science finds the rest of them.

  6. jpmd says:

    This is a really thoughtful and well written piece. As to why some docs go to dark side, my only answer is “greed.” Those who do not know better can be excused somewhat, as I believe they are sincere in their belief that what they say or push is real. the Oz’s and Chapra’s of the world however know better, and still promote it, so they deserve our disgust.

  7. windriven says:

    @Steven Parker, M.D.

    “Or they’re outright charlatans.”

    A few probably are. The Lizard of Oz leaps to mind. But isn’t it likely that many physicians just adopt the stance that ‘it probably won’t hurt’ (and it pacifies them and gets them out of my office).

    One reason that the profession really must take a hard line with high profile MD quacks is that it is that many physicians in the trenches might not have the time, education or interest to explore the details of quackery critically. As Dr. Crislip pointed out:

    “There is little time for most doctors to read all the medical literature carefully, and usually little need. We have people and institutions we use as surrogates .” (italics mine)

    It is important that these surrogates not be quacks. The medical profession owes it to itself and to the community it serves to play an aggressive game of whack-a-mole with those in the medical community who would pollute the practice of medicine with magic and woo.

  8. Decent commentary on SCAm, but the first part, abt the training of physicians, what that world is like, and what physicians do, is golden. I may use it to illustrate this world for the non-clinician students and researchers I work with. Thanks for writing that first part so well. [The rest is good, too.]

  9. Tell it like it is says:

    DOCSTAR HUSTLES HUXSTER

    Sparkling!

    Contact Pen Jillette or Rudy Teller (or their agent) and use your influence to organise the people to whom you refer to be guests on the P + T Bullsh!t show and see how they fare!

    http://en.wikipedia.org/wiki/List_of_Penn_%26_Teller:_Bullshit!_episodes

    We await the new season.

    TILIS

  10. Nikola says:

    Epic post, touching many related but different subjects.
    Thank you.

  11. Zetetic says:

    MDs that subscribe to various sCAM modalities… Yes, I’m amazed at how many MDs from the University of Washington Med Center have become affiliated with Bastyr ND!

  12. Wholly Father says:

    Very poetic post. Well done.

    The CAM community has really latched on to the decline effect. They somehow see it as a justification for the special pleading that CAM effects are invisible to scrutiny from evidence-based methodologies.

    If a therapy has no observable effect to begin with, does the decline effect predict that it will become harmful over time?

  13. weing says:

    Maybe the CAMsters figure that they can claim an augmentation effect.

  14. Chris says:

    Zetetic, it also depresses me! Fortunately the percentage is not 100%.

    Today I ran across this posting by Dr. Ben Goldacre: A reader’s anecdotal experience of cranial osteopathy.

    For the uninitiated, it is also called cranialsacral therapy, and is best described as a “homeopathic head massage.” Since my son was diagnosed with some severe speech/language disabilities due to seizures as an infant, this SCAM has been recommended to me several times.

    Most recently just a few years ago when he was twenty years old. I usually respond that massaging his head will not fix the damage in Broca’s and Wernicke’s areas of the brain which is at least an inch inside the skull. They usually shut up.

    I don’t care if I am not quite anatomically correct, just the fact I know the names of the speech and language areas shut them up. The latest being an unemployed chiropractor who claimed to know neurology. Since it was at function for women to find new careers, I was not impressed. (yeah, I had to quit my job over twenty years ago to deal with a disabled kid, which I am still dealing with)

  15. Tell it like it is says:

    @Chris

    I am very deeply moved by the way you have put all of this SCAM nonsense into clear perspective and the laudable method you use on an ‘as-need’ basis to put these deluded people firmly in their place is both impressive and brave.

    I believe we ALL fully endorse Mark Crislip’s observation “Thinking, specifically CRITICAL THINKING, is not high on the list of abilities that are needed to become or be a doctor. Day to day, doctors need to think clinically, not critically. Clinical thinking consists of synthesizing the HISTORY, the physical and the diagnostic studies and deciding upon a diagnosis and a treatment plan.”

    For mankind to progress requires and needs LOGIC and ANALYSIS, but it also requires the ability to see the big-picture and this involves a creative mind to discover SOLUTIONS to problems.

    “The fear of making a mistake, of risking an error, or of being told you are wrong is constantly with us. And that’s a shame. If your state of mind is coming from a place of fear and risk avoidance, then you will always settle for the safe solutions – the solutions already applied many times before that APPEAR to work (possibly because of the placebo effect – TILIS). Failing is fine – necessary in fact. But avoiding experimentation or risk—especially out of fear of what others may think – is something that will gnaw at your gut more than any ephemeral failure. A failure is in the past. It’s done and over. In fact, it doesn’t exist. But worrying about “what might be if…” or “what might have been if I had… ” are pieces of baggage you carry around daily. They’re heavy, and they’ll kill your creative spirit. Take chances and stretch yourself. You’re only here on this planet once, and for a very short time at that. Why not just see how gifted you are?”” (Daniel Garr)

    To date we have not discovered a CURE for the crippling disease poliomyelitis (AKA polio) so we take the logical ‘prevention is better than cure’ route and administer a vaccine. The breakthrough to achieve this was achieved through CLINICAL THINKING and was achieved by a RESEARCH GROUP at the children’s hospital in Boston Massachusetts.

    The first successful vaccine against this debilitating disease was developed by Jonas Salk and 5 years later an oral vaccine was developed by Albert Sabin who applied CRITICAL THINKING to crack the problem.

    Thanks to these two people, who applied CRITICAL THINKING, and also thanks to the efforts of the World Health Organisation (WHO), these two vaccines have reduced global incidence of polio from around 350,000 cases in 1988 to less than 1,700 by 2007. Sadly, it is the volatile situation that exists in West Africa and other parts of the globe that prevents complete reduction of incidence until a cure can be found.

    Whilst, as discussed above, CLINICAL thinking takes many YEARS to acquire as a skill and transfer until it becomes a HABIT, CRITICAL THINKING tests are readily available, and of these, probably the best known is the ‘Watson-Glaser critical thinking appraisal’.

    Here are a few simple examples on the sub-set LATERAL THINKING (with answers below):

    1 What can you hold in your right hand, but not in your left?

    2 If you were alone in a deserted house at night, and there was an oil lamp, a candle and firewood and you only have one match, which would you light first?

    3 What can you put in a wooden box that would make it lighter? The more of them you put in the lighter it becomes, yet the box stays empty.

    4 Divide 40 by half and add ten. What is the answer?

    5 A man and his son were in a car crash. The father was killed and the son was taken to hospital with serious injuries. The examining doctor exclaims: “But, this is my son!”.
    How can this be?

    Having shown your unremitting and unconditional love to your son, I observe that you are now seeking highly deserved ‘me-time’ and that you attended a function for women to find new careers. Having read your very moving post, may I suggest that options that seem apparent to me are ‘investigative journalist’ and ‘writer’ (your own life’s commitment to your son and your encounters with charlatans on your journey would make a wonderful story).

    To the former, may I be audacious and recommend:

    - Journalistic Writing: Building the Skills, Honing the Craft – Robert M Knight
    - Writers and Artists year book

    To the latter:

    - How to write a Mi££ion – Dibell, Scott, Card and Turco
    - The Whole Art of Storytelling – Michael Dirda (due out in August)
    - Art – the whole story – Stephen Farthing
    - A series of unfortunate events by Lemony Snicket

    My last recommendation is a 13-part masterwork by Daniel Handler who writes a ‘chronicle’ that is ATTESTED to be written by ‘Lemony Snicket’. Lemony Snicket is in fact a character WITHIN the book who is writing the chronicle of the Baudelaire children. It’s a cracking piece of juxtaposition!

    Who knows, rather than physically, mentally, and emotionally box yourself in some factory or retail outlet somewhere, you could become the next J K Rawlins!

    May I also recommend two DVD’s.

    On applying CRITICAL THINKING to crack a problem, it has to be the very moving film ‘Lorenzo’s Oil’ starring Susan Sarandon and Nick Nolte.

    To give a taster for great storytelling there are few films to match ‘A series of unfortunate events’ (which stars Jim Carey and contain the stories from the first three books – and Violet Baudelaire’s dress is a masterpiece fit for Princess Kate).

    By now you are probably champing at the bit to know the answers to the questions on lateral thinking – a branch of critical thinking. Here they are:

    1 Your left elbow
    2 The match
    3 Holes
    4 There are 80 ‘halves’ in 40 so 80 + 10 = 90
    5 It is his mother – women can be doctors too!

    Very best wishes,

    TILIS

  16. Chris says:

    The audio books of A Series of Unfortunate Events are excellent. All but three are read by Tim Curry with great relish (the ones read by Handley are okay).

    I’m thinking of bringing a doll and toy hammer to TAM 9, so that we call all practice Tong Ren! I also have promised to buy Dr. Crislip a beer.

  17. Chris says:

    4 Divide 40 by half and add ten. What is the answer?

    40/2 + 10 = 30

    I used to be a structural dynamics engineer, I dealt with complex matrices, second order nonlinear differential equations, Euler’s formula, Fourier transforms and other advanced engineering mathematics.

    I have a strong dislike of riddles with missing bits of information. And in my world if you included the missing “divide by half over and over again” I would say that the number of halves was infinite, the value would get close to zero and adding ten would make it 10.

    Because I just don’t like being bound by real integer algebra.

    And condescension.

  18. Chris says:

    Oh, and I really hate word play riddles:

    4/.5 + 10 = 80 + 10 = 90

    Still dislike the condescension.

  19. Jerry Schwarz says:

    I’m not a physician myself and except as a patient I don’t have a lot of contact with them, but I recently had an experience that suggests things are even worse than this blog entry suggests.

    The son of a friend of mine recently graduated from Stanford medical school. I had lunch with him and a friend of his who was entering the last year of medical school. At one point I turned the conversation to CAM and in particular asked them about acupuncture. They said it was a placebo, but that was ok. In some circumstances they said they were taught it is ok to say to a patient something like “I don’t know how it can work but a lot of my patients have had success with acupuncture.”

    That was disturbing in itself, but the conversation suggested they had been taught by professors sympathetic to CAM. Several times they referred to “Western Medicine” and when I challenged them that they really should talk about “Scientific Medicine” they said science was a western invention. A couple of times they used the phrase “allopathic medicine”, which according to Wikipedia “it was adopted by alternative medicine advocates to refer pejoratively to conventional medicine.”

    This was a celebration so I let the subject

  20. Tell it like it is says:

    @Chris I am surprised, dismayed, and saddened at your reply; particularly given that you are a structural engineer who deals with complex matrices, second order nonlinear differential equations, Euler’s formula, Fourier transforms and other advanced engineering mathematics.

    My sadness is not because knowing you are a structural engineer does not add anything to the topic; nor is it because of your assumption that the question failed to include the ‘missing’ “divide by half over and over again” when the question didn’t seek an answer to THAT enquiry; neither is it because the whole point of my post and lateral thinking test was to illustrate the NECESSITY to invest time in how to think CRITICALLY and was meant to be ILLUSTRATIVE, and not written in any condescending manner whatsoever; nor is it the fact that N divided by ‘one over TWO’ = N X 2, as in – there are two halves in one, so there must be 2 X 40 in forty, ergo, 2 X 40 = EIGHTY. No – it was NONE of the above that caused my sadness. My sadness was because you have elected to show yourself up by failing to thing CRITICALLY – which was ONE of Mark Crislip’s many observations when he made the point that “Thinking, specifically CRITICAL THINKING, is not HIGH on the list of abilities THAT ARE NEEDED to become or be a doctor” It clearly IS.

    To stay ‘on topic’ and progress the discussion. Mark Crislip makes the observation that Medicine is rife with CONFIRMATION error. I believe that these errors occur for a variety of reasons; including:

    - The exorbitant costs of REPLECATION of tests to CONFIRM an ASSERTION.
    - The mathematical tools and APPROACHES used are RESPONSIBLE for the massive COST.
    - The MATHEMATICAL METHODS and tools used to derive the ASSUMPTION contain FLAWS. The largest flawed premise is one of ASSUMING most variables in life are INDEPENDENT. As a result, the statistical methods statisticians use, look for ASSOCIATIONS – and when they find one – oh boy – we get everything from scaremongering to the SCAMS under discussion here!
    - The SOUNDNESS of the current way we EVALUATE is seldom scrutinised.
    - Other approaches such as application of Bayes Theorem, Occams Razor, or second order nonlinear differential equations (as examples) are not readily deployed, either because of a lack of application popularity, lack of application ability, or ignorance of the methods.

    And please do not draw the conclusion that I am being sarcastic, nor accuse me of condescension when I include second order nonlinear differential equations in my ‘approach portfolio’ – I’m not – and here is why:

    In biology and medicine the biological landscape immediately MODIFIES itself the moment WE attempt to change something ON that biological landscape, as confirmed by the findings of AUGUSTO ODONE, shown so beautifully and explained so clearly in the superb film ‘Lorenzo’s Oil’. So rather than DATA-MINING, in light of THOSE facts, maybe we should be applying second order nonlinear differential equations to our quest for answers and solutions.

    In the polio example I gave, I deliberately NEGLECTED to state that in the forerun to determining a vaccine that WORKED, early CLINICAL trials on several thousand children in America produced severe allergic reactions but NO immunity, and one strain was blamed for infecting children with paralytic polio – which resulted in NINE DEATHS!

    Mark Crislip makes the observation that “I have discussed before how sometimes I can come to the correct diagnosis with minimal information, almost INTUITION, and then explain after the fact HOW I came to the diagnosis. It almost feels like the answer bubbles up from BELOW AWARENESS. It is MOST PECULIAR how much of my medical reasoning occurs BELOW MY CONSCIOUSNESS”

    One’s unconsciousness has an AMAZING ability to send up smoke-signals.

    For the MOST part – that is for the GOOD; and a wise EXPERIENCED practitioner recognises this. But equally, the subconscious sends up, not only smoke signals, but smoke SCREENS that can obscure, distort, and sometimes DESTROY your vision.

    I am of the firm belief that we do not INVENT – we merely DISCOVER. Medicine is a process of DISCOVERY. Application of CRITICAL THINKING greatly AIDS that process. The rhetoric might be forceful; the grammar might be impeccable; but if the LOGIC is wrong, just as 4/0.5 + 10 = 90 is wrong – its WRONG – PERIOD!

    THAT and ONLY that was the point that I was making.

    Did I miss a point somewhere?

    Not enough people jump down the rabbit hole and join Alice in wonderland.

    Very best wishes

    TILIS

  21. Tell it like it is says:

    DOCSTAR HUSTLES HUXSTER (2)

    Throughout history it has been shown that every TRUE singular causal statement relating to two events is backed by a LAW that covers those events WHEN PROPERLY DESCRIBED – and this applies to ALL sciences – including medicine. Examples include Kepler’s Law, Ohms Law, Boyles Law, Charles’ Law, Kelvin’s Laws, Boole’s Laws, and Newton’s Laws.

    Newton’s laws – covering everything from motion to gravity, and everything else in-between, as described in the ‘Principia’ are NOT based upon some arbitrary set of calculations. As David Hume informs – they are DERIVED from OBSERVATION. In other words, what Newton has done in giving the world the Calculus, is define a set of ‘summations’ – as in ‘surmise’ – that closely fit REALITY.

    Whether you wish to use Newton’s Law of cooling to determine when the temperature of your freshly made coffee is at the temperature you enjoy, or use the Calculus to determine the amount of lead in the atmosphere, or the total amount of radioactive build-up; in ALL life sciences Newton’s ‘improper integrals’ based upon OBSERVATION return some VERY surprising results that defy INTUITION.

    WHEN PROPERLY DESCRIBED is KEY! To illustrate, the “divide by half over and over again” principle refers to the ‘half-life’ calculation used to calculate decay.

    It is used in many applications including calculating depreciation, and it is the ‘half-life’ calculation that is used to ‘carbon-date’ artefacts – but APPLICATION of the calculation has a serious FLAW that has had scientists laughing louder than when Anders Celsius made his THREE bloopers back in 1742 – as follows:

    When Celsius originally devised his ‘scale’, he made the freezing point of water = 100 degrees, and the boiling point of water = 0 degrees which implied that as a body gets hotter the temperature drops. Really.

    He calibrated his ‘temperature’ scale from an ARBITRARY point, resulting in ‘negative’ values for temperatures BELOW this arbitrary point – i.e. that somehow temperatures ‘disappear’ into some sort of negative universe (anyone seen my negative tea cup?).

    He called his scale the CENTIGRADE scale – i.e. it only has 100 units and as zero = the freezing point of water and 100 = the boiling point of water, it has no application to the temperature of a body OUTSIDE of these temperature ranges.

    Returning to ‘carbon-dating’, using carbon-dating there was a point when the geologists had confirmed that the Earth was older than the Universe it sits in – how does THAT work?

    But let’s stick with the elusive TWO. The twelfth root of two (~ 1.0595), representing the 12 notes in an octave; calculates the interval between each note on the Western music scale (i.e. given ‘A’ = 440 Hz, ‘A#’ = 440 X 1.0595 = ~466.16 Hz, ‘B’ = 466.16 Hz X 1.0595 = ~493.88 Hz …..

    Fascinating. Why has an octave got 12 notes?

    Intelligence is something we are born with. Thinking is a skill that must be learned. (Edward de Bono)

    Anyone for tennis? I’m off to watch Wimbledon in 3D.

    Have fun

    TILIS

  22. nybgrus says:

    This is all very strange. Chris, I respect your posts immensely, and I applaude your efforts both here and IRL.

    TILIS – ???

  23. Reading recommendations for Tell it like it is

    Might I recommend Basho and Hemingway?

    Also a quote, overused in high school, often ignored online.

    “Brevity is the soul of wit.”

    -Shakespeare

  24. Chopra – (via MC) “The inconvenient truth that “you can heal yourself” has always been the foundation of medicine. The body is the locus of the healing system; physicians assist this complex, little-understood system. They do not actually do the healing. If this feels threatening to MDs, there is much more room for pride to take a fall.”

    I really don’t get that paragraph. If I have a condition that I can heal myself, I don’t go to the doctor.

    My son’s cleft lip and palate didn’t ‘heal itself’ the fluid behind his ears and repeat ear infections didn’t ‘heal itself’. I don’t think that my MIL’s blood clots were going to ‘heal themselves’ (safely) My auto-immune thyroid condition didn’t ‘heal itself’. In fact, with the focus on

    “the body as an integrated system that exchanges information continuously between the mind, via the brain, and every cell in the body.”

    It seems easy to forget that our integrated system has no more wisdom than a flock of chickens that will turn on one of it’s members for some small reason ( a few lice?) and insidiously peck it until it is bald and sickly (but maybe I am misunderstanding chickens)

    It seems to me that Chopra and many of the proponents of CAM have grown so used to not seeing all those people who need real medical care, that they forget that we exist. They seem to prefer to only notice the people who’s condition will be improved through the use of a placebo or a change in diet/activity level.

  25. GLaDOS says:

    Tell it like it is,

    The comments section is conversational. That means you say a little bit of something, someone else says something, and so on.

    When you post a tl;dr essay in the comments, most people will skip what you write. No harm no foul there. However, the scrolling kinda disrupts the conversational flow.

    Also, rules of capitalization.

  26. Chris says:

    Yeah, I am totally going to scroll through “Tell it like it is” long posts. I could go without being told that critical thinking involves solving word riddles. I used to be an engineer, so I much prefer concise communication.

    I should have ignored him/her with first demeaning sentence.

    Did anyone even look at the article on Ben Goldacre’s secondary blog? It showed how going by what seemed like innocuous advice, spending lots of money on homeopathic head massages, and that not one of those alt-med practitioners caught that the child had a very severe issue with a fused skull?

  27. Tell it like it is says:

    Happy Independence Day everyone.

    TILIS

  28. Tell it like it is says:

    @ Micheleinmichigan

    Ah The Bard The man who did writteth plays for Queen Elizabeth the Benevolent (AKA The Virgin Queen) to aid her comprehension of matters in the court; the man who gave the world the greatest plays ever written.

    Wasn’t he the man who wrote 884,429 words, in 34,896 lines, in 28,829 word forms, spoken by 1,221 characters?

    We’ve a lot of catching up to do methinks.

    Whilst I consolidate my word count to pleaseth the crowd, lest my observations fall upon deaf ears, like the ears of corn that felleth on stony ground in the parable of the three kernels of corn, please haveth fun and enjoy your day as I wish one and all a glorious Independence day, with a hey nonny no and a hot cha chah.

    TILIS

    PS: LOVE Ernest Hemmingway. Decadence is a difficult word to use since it has become little more than a term of abuse applied by critics to anything they do not yet understand or which seems to differ from their moral concepts.

  29. Tell it like it is says:

    @GLaDOS

    On CAPS and conversations.

    The Queens English is a ‘strange’ beast. To convey what one is ‘communicating’ relies upon ‘stress’ on the ‘syllables’ within a ‘word’; and ‘also’ relies upon the stress ‘applied’ to the words contained within the ‘sentence’ (called inflexion).

    Take the word ‘present’ for example. If we stress the ‘first’ syllable it is a ‘noun’ (a present) or an ‘adjective’ (present is the opposite of absent); but if we stress the ‘second’ syllable then the word becomes a ‘verb’ where ‘present’ means to ‘offer’ – may I present Miss Diana Ross.

    On inflexion; placing stress on ‘any’ given word within a ‘sentence’ completely changes the ‘meaning’ of that sentence.

    Try it for ‘yourself’. Construct a four word ‘sentence’ and ‘speak’ it out ‘loud’, ‘stressing’ each word ‘within’ the sentence – ‘one’ word at a ‘time’ – beginning with the word that ‘starts’ the sentence, and then working your way through. As you will hear, ‘observe’, and ‘digest’, changing where you choose to put the ‘emphasis’ ‘completely’ changes the ‘intent’ contained within the sentence.

    Read this ‘next’ sentence then, by way of an ‘answer’, say the phrase out loud to answer the questions that follow – placing ‘stress’ on the ‘appropriate’ word to accurately convey your ‘intent’. The cat sat on the mat.

    Who or what sat on the mat?
    What pose did the cat adopt when it went onto the mat?
    Did the cat sit to one side of the mat?
    What did the cat sit on?

    To convey this same ‘sense’ when reading the ‘printed’ word to give ‘emphasis’ to what we are attempting to ‘put across’, relies upon some means beyond ‘punctuation’ marks to convey the ‘stress’. That is ‘one’ of the ‘many’ limitations we encounter when attempting to convey ‘meaning’ on the page.

    We may choose to use ‘italics’ or we may chose to ‘embolden’ or even ‘underline’ a ‘word’ to draw attention to where we wish to convey ‘emphasis’, but as application of these tools are stripped away when one posts a ‘response’ I have retorted to ‘capitalising’ words where I wished to placed ‘stress’, so as to accurately convey ‘meaning’ and ‘intent’.

    In ‘Britain’, ‘underlining’ a word or phrase is considered not only to be bad ‘form’, it is ‘also’ perceived to be ‘extremely’ rude.

    I ‘do’ appreciate that when one is communicating using an ‘electronic’ platform, that where once upon a time one would have ‘conveyed’ an action by ‘describing’ that action; and that the use of ‘capitalisation’ is taken to ‘imply’ that one is ‘shouting’ as opposed to ‘stating’ one is shouting (… and I heard her shout “Mum – where are you!”), but ‘adopting’ such a precept is not only a ‘sloppy’ use of English, and ‘adopting’ it is being ‘lazy’ and dare one say it – ‘uncouth’; it goes ‘much’ deeper. It is ‘blind’ ‘acceptance’ that it is OK to ‘destroy’ the very fabric of the ‘common’ language we ‘rely’ upon to convey our thoughts, words, and ‘deeds’ to each other – and in professions where ‘intent’ is ‘all’, this form or language destruction would be regarded as ‘unprincipled’.

    Let me ‘ask’ – do ‘you’ use ‘capitalisation’ when giving ‘presentations’? Do the target audience assume that you are ‘shouting’ at them and take offence?

    With ‘no’ other means at my ‘disposal’ to communicate where I am placing ‘inflexion’, so as to convey ‘sense’ and ‘comprehension’, as I thoroughly enjoy this site’s subject matter, and I get ‘totally’ engrossed in what people have to say on the ‘topics’, ‘and’ I enjoy the ‘dialogue’, and most ‘certainly’ do not wish, in ‘any’ way, to cause ‘offence’ to ‘anyone’, but rather have merry ‘banter’ peppered with ‘humour’ and good spirit to put ‘my’ point of ‘view’ across, what would you have me ‘do’?

    This is ‘so’ pertinent to ‘this’ discussion and ‘all’ discussions that follow. Today’s world of ‘shoot-or-be-shot’ games – both ‘real’ and ‘imaginary’, has resulted in very low attention-span for most. This is ‘sad’, because it means, for the ‘most’ part anyway, that the art of ‘dialogue’ and ‘philosophical discussion’ is a dying art.

    It is discussion that brings this tiny community together. It is ‘through’ discussion ‘we’ become ‘enlightened’ and derive ‘fellowship’. Please do not stifle ‘parlance’, nor confuse or destroy ‘badinage’ because it destroys the ‘relevance’ of what we are attempting to ‘do’ here – ‘enlighten’ and ‘discuss’ – and it ruins ‘good conversation’ – for ALL.

    Sincerely,

    TILIS

  30. Chris says:

    Thank you, nybgrus.

  31. Nikola says:

    I shall have to be neutral about the length of comments, but the answer to the #4 question by TILIS is quite correct (and in my mind, fun). To get annoyed or expect conciseness is to forget the entire point of lateral thinking puzzles.
    “To divide by half” isn’t the same as “to halve”. The first essentially means, mathematically, “to double” ie to divide “/” by half “0.5″, which is the same as multiplying “*” by 2.

    In any case, your perspective is indeed invaluable, Chris. Thank you.

  32. Chris says:

    I realized that later. That is the problem with reading quickly on blogs, you tend to get tripped up by wording.

    Which is why critical thinking is not the same as solving word riddles.

    Still don’t care what he thinks. It seems common sense that gentle head massages are not going to cure brain damage.

  33. Tell it like it is says:

    DOCSTAR HUSTLES HUXSTER (3)

    Its funny how when people are given something for ‘free’: be it valuable or useful information, or two theatre tickets to see a review of a show, so that the producers may gauge reaction and obtain feedback, many will ‘look a gift horse in the mouth’ – a term which here means ‘check the soundness of the gift’.

    The person receiving the free advice ignores it, and the people attending the free show generally condemn the show, and in so doing, destroy their enjoyment – which is a form of ‘self-harm’ – no different to smoking or drinking. And there lies the rub.

    As Mark Crislip illustrates, there are a lot of hoops to jump through if you wish to become a doctor. On the other hand, implementing a SCAM takes minimal effort.

    I believe, what sets Doctors apart from scammers is this: Doctors base their diagnosis on many years acquiring trusted knowledge that works, whereas, scammers know they are scamming.

    The reason scammers who promote and sell medicine-based religion get away with it is exacerbated by the fact that a) they dress the part; and b) they charge money.

    When a person pays for ‘advice’ – they BELIEVE it. It is a strange derivative of the term ‘put your money where your mouth is’.

    Medicine-based religion has both feet planted in cheap vaudeville, childish posturing, and dishonesty, and is not a science. The scammer cheats and this truth runs cold through the craft’s bloodless veins.

    Hope you all had an enjoyable Independence Day and you found a little time to celebrate.

    Best wishes,

    TILIS

  34. Tell it like it is says:

    DOCSTAR HUSTLES HUXSTER (4)

    To summarise my contributions to this discussion:

    1. Use ‘name and shame’ to DESTROY scammers.
    2. Train your mind to move from a state fear and risk avoidance, to one of taking chances through Accountability, Collaboration, Transparency, and Stretch (ACTS) – in other words don’t just bleat – ACT!
    3. Deploy ‘critical thinking’ to broaden your ability to find solutions. Have a crack at the ‘Watson-Glasser critical thinking appraisal’ – you may well come away surprised – you will certainly come away enlightened.
    4. Tell YOUR story to the world.
    5. If you are the steward of someone who needs your care, do not physically, mentally, emotionally, or spiritually box yourself in some job-prison where you are unable to take effective action against charlatans – no matter how pretty the cell looks.
    6. Never use the tools of the charlatan in an attempt to deceive them – you will be found out – and some will hunt you down through employment sites – FACT!
    7. Scrutinise the soundness of the current way we evaluate and challenge the tools and approaches.
    8. Create an ‘approach portfolio’ to test and validate other approaches alongside current practice.
    9. Look out for smoke screens amongst your smoke signals, and continuously question your own judgement so as to sharpen it.
    10. Do not be lured into ‘honey traps’. Do your homework to check the soundness of the offerings.

    The term ‘To look a gift horse in the mouth’ – a term which here means ‘check the soundness of the gift’ refers to a ploy devised by the Greeks to heroically end the ‘The Trojan War’. They achieved this by presenting a huge wooden horse as a ‘peace offering’ to the Turks.

    The horse was hollow, and hidden inside were an elite force of 30 Greek assassins. The horse was towed into the Turkish citadel of Troy (now called Side – pronounced see day), and under cover of darkness, the assassins overpowered the guards and opened the gates. The Greek army entered and destroyed the city, which decisively put an end to an extremely bloody and pointless war.

    The ‘gift horse’ theme appears in ‘A series of unfortunate events’ (book the seventh – ‘The Vile Village’) a thirteen part chronicle of the Baudelaire children by ‘Lemony Snicket’. The ‘gift’ is a fountain of a crow, and – for reasons that become apparent – it is called ‘Fowl Fountain’ – a play on the word ‘foul’ – a word which here means treacherous.

    Regrettably, in our desperate quest for treatments to cure debilitating diseases, we encounter scammers who have us running round and round in circles; kept in the dark; staring at the same thing over and over and over – with mortal danger ever present, while we seek to find a way out. This theme is explored in ‘A series of unfortunate events’ book the fifth – ‘The Austere Academy’.

    Medicine-based religion has both feet planted in cheap vaudeville, childish posturing, and dishonesty, and is NOT a science. The scammer cheats and this truth runs cold through the craft’s bloodless veins.

    The rhetoric might be forceful; the grammar might be impeccable; but if it doesn’t work – its WRONG – PERIOD!

    SOS DD – YEP – Save Our Souls

    Best wishes.

    TILLIS OUT

    PS: Side is located in the south of Turkey and filled with very welcoming people who’s sole aim in life is to feed and entertain you, and sell you mock turtles (soup anyone?). Should you visit so as to see and touch the ancient monuments, make sure you book a trip to see Petra – the city carved IN the mountain.

  35. Jim Laidler says:

    The argument used by Chopra (and other SCAM apologists) is that “mainstream” medicine has its flaws, so SCAM must be better (or at least as good). This is similar to arguing that since parachuting is dangerous, so you would be as well (or better) off jumping out of the plane without a parachute.

    Chopra also misses out on a masterful insight when he says:

    “The real mystery…is that so many therapies that totally disagree with one another manage to bring results. Ayurveda isn’t qigong; yoga isn’t Reiki; none of them is a placebo.”

    So close, but he misses it in the final phrase. Of course, one explanation for the “fact” that ayurveda, qigong, yoga and Reiki all “work” in the same way is that they are all placebos. That would be the simplest explanation and – in fact – the only one supported by what we know about biology, chemistry and physics.

    Jerry Schwartz recalls:

    In some circumstances they said they were taught it is ok to say to a patient something like “I don’t know how it can work but a lot of my patients have had success with acupuncture.”

    When I was doing my fellowship, an attending physician suggested that patients who – after careful evaluation – had no discernible malady to explain their symptoms could be “eased out the door” with a suggestion to try acupuncture or chiropractic. His argument was “It can’t hurt (not true, as it turns out) and it will make them feel like something is being done.”

    I never used that advice (it felt a lot like lying to the patient), but I remember it whenever a patient or acquaintance tells me that their doctor suggested acupuncture or other SCAM therapy.

    Jim Laidler

  36. Harriet Hall says:

    @TILIS,

    Do you suffer from hypergraphia? Compulsive disorders can be treated with psychotherapy and medications. Have you considered getting help?

  37. Dr. Crislip is my hero.

  38. Tell it like it is says:

    @ Harriet Hall

    Hi Harriet

    If your assertion is valid then that puts me in the hallowed company of Alan Hovhaness, Fydor Dostoevsky, Vincent Van Gogh, Lewis Carroll (in the top 3 of my favourite authors next to Shakespeare and Laurence Sterne) and William Shakespeare. WOW! That is some compliment for my humble contributions to bring a different philosophical standpoint and light-hearted merriment to the discussions, through the application of ‘stream of consciousness’ thinking to broaden perspectives.

    I will say this. I am an avid reader, and I am blessed with an encyclopaedic knowledge on many subjects with almost instant recall, as did my father and my grand-father – but I don’t have the urge to write unless I am impassioned to do so – and I don’t keep a diary and I have never had the urge to do so.

    I apologise to you and anyone else who reads my personal reply to you for being off-topic but I trust that you see that I acknowledge your comment and appreciate your concern and advice.

    Kindest regards,

    TILIS

  39. Harriet Hall says:

    TILIS,

    I don’t know what your diagnosis is (bipolar, perhaps?) but something is definitely “off.” You are displaying grandiosity and narcissism. You have to be conceited to think we would want to listen to your stream of consciousness. Good for you if you are “in hallowed company” and have “encyclopedic knowledge” but these comments are not the appropriate place to display your encyclopedic knowledge. Imagine how the comment threads would degenerate if everyone displayed their stream of consciousness like you do. I suspect most readers are not even reading your logorrheic comments at this point. Please try to be more concise and to say things that contribute directly to a constructive dialog instead of just saying everything even remotely related that pops into your mind.

  40. woo-fu says:

    Patients use SCAMs for a variety of reasons, and I do not pretend to understand why people prefer magic over reality. 

    It is incorrect to assume that people who choose to experiment with alternative therapies are magical thinkers, even though many may be, or that they do not take the time to think critically about treatment.

    Some patients are directly advised to explore CAM, especially when a primary physician or even a specialist cannot detect or understand the real disease underlying a patient’s symptoms. I was told to try acupuncture, in spite of my doubts, by my former primary physician and two specialists, not because they believed it was placebo; these doctors believed acupuncture really works. They each had a slightly different hypothesis regarding how it worked, of course. Two of the three had tried it themselves and found it quite helpful. All of their explanations were body-based, not couched in metaphysical language. Still, it didn’t really do much for me besides lighten my wallet and cause me to become even more skeptical of my doctors.

    Other times patients are told (rightly or wrongly) that their illness is all in their heads, and they are directed to psychiatrists and psychotherapists, who then encourage stress reduction techniques, therapy and/or medications when indicated. Since many physical illnesses are directly influenced by stress, reducing stress, even with so-called alternative techniques, may well precipitate a decrease in symptoms. This is not a cure, nor do I believe it is a placebo since there are no real expectations, but any help in such complex cases is usually welcome. The downside however is that the patient may temporarily feel better even while an underlying disease process is worsening.

    Regarding the ethics of prescribing CAM treatments, as long as doctors suggest them as possible avenues for stress reduction, I don’t see a major problem. But they must stay clear of any promises regarding efficacy, alert the patient to any risks regarding the therapy and remind the patient that persistent medical problems must still be monitored. Nothing a patient does to improve quality of life outside the doctor’s office substitutes for good science-based medical care.

  41. Tell it like it is says:

    @ Harriet Hall

    Hi there

    I don’t recall anywhere asking for a tirade of abuse, nor do I understand why you have totally strayed away from the topic under discussion.

    Have you applied the same uncouth rules by which you judge me to the person who wrote the wordy article under discussion? And if so, out of ten, how did they score on your ranking of:

    - Hypergraphia
    - Compulsive disorders
    - Bipolar mood swings
    - Grandiosity
    - Conceit
    - Narcissism

    And given what you have published here, how are others to judge your remark: “I have two posts scheduled for later this month that will address …” Will they? Nine out of ten for condescension, plus ten out of ten for getting in a plug!

    And on being narcissistic, your comment: “Check back on July 19 and 26.” Why? Ten out of ten for pomposity.

    I suggest you read this quote from GlaDOS:

    “Most doctors wouldn’t want to cause their patients more harm than good, so you really have to wonder about the ones that choose to specialize in psychiatry. Do you think they’re the dumber students in their med school class, or just a little more evil than the rest?”

    In Britain we combine the best traditions from our justly world famous Public, Dame, Monitorial, and Charity schools, and our British institutions. These have all contributed so much to enrich the varied heritage of British education, unique in the world, and make us the most inventive nation ever – bar none. Our inventions include the very platform you have used to express your character – the internet.

    I had expected to enjoy the experience here with clever witty people who do not have to spoon-fed tiny morsels of information for fear of information overload. I should hardly have come if I hadn’t expected anything different.

    http://www.bbc.co.uk/news/world-us-canada-11568093

    Please try to be more concise and to say things that contribute directly to a constructive dialog instead of just saying everything even remotely related that pops into your mind.

    Now where have I heard that before?

    I rest my case.

    TILIS

  42. Mark Crislip says:

    My statement was SCAM is magic, not that those who use it are magical thinkers. A slight difference.

  43. woo-fu says:

    @Mark Crislip

    Patients use SCAMs for a variety of reasons, and I do not pretend to understand why people prefer magic over reality.

    You’re right, in the first part of that sentence you did state that people use “SCAM” for many reasons. I must have inferred, from the second part of your sentence, that you were implying anyone who practiced those techniques preferred to think magically. I don’t think that was much of a stretch, but I stand corrected.

    However, by using the term “SCAM” you also seem to imply no value. I am simply asserting there are, at the very least, some stress-relieving qualities and perhaps physical therapy benefits that may be learned by experiencing some of what you call SCAM.

    That individuals may choose to explore these techniques does not automatically make them ignorant, lazy thinkers or wand-waving wizard wannabes. Not all practitioners that employ them are intentionally trying to dupe their patients. The absolutist rhetoric prevents understanding the more complex reasons that patients seek help where they do.

  44. woo-fu says:

    I do support the main emphasis of your post, the lack of critical thinking in the medical profession in general, which should be evident from the examples provided in my original comments.

    IOW–I’m not really trying to nitpick your work. I just objected to what I saw as an unfounded generalization.

  45. nybgrus says:

    That individuals may choose to explore these techniques does not automatically make them ignorant, lazy thinkers or wand-waving wizard wannabes. Not all practitioners that employ them are intentionally trying to dupe their patients.

    Nor does anyone here think so. The “absolutist stance” is towards the practitioners and purveyors and sCAMs, not the consumers. I admit I stole this from Dr. Gorski’s comments over at a comments thread to his open letter to Francis Collins but it is a good read (link)

    In fact, I have argued myself that the reason we here and as physicians need to have more of an absolutist stance is precisely because of the large subset of the population of CAM users that aren’t magical thinkers but are essentially suckered into it by thinking there is some sort of scientific basis for the supplement/treatment they are taking. It is perfectly reasonable, as a consumer, to think that the bottle of pills on your local pharmacy shelf would be both safe AND efficacious – not many really realize what the DSHEA allows and what the means. They would also assume that because someone is “licensed” that means there must be something legitimate to what they do (NDs, acupuncturists, etc). These people aren’t intentionally seeking out and consuming magic – they think they are being legitimate and while many realize a bit “fringe” they still don’t think it is pure joo-joo.

    And of course not everyone who practices it is trying to dupe people. Many are genuinely convinced their woo actually works and are doing it to help people. That is just another reason to educate and hold firm in our collective stance here. Just look at Ben Kavousi as an example – he trained as an acupuncturist and after some years finally realized what a crock it was. Now he writes here on SBM about it to educate others who may fall into the same plight in addition to potential consumers of acupunture.

  46. woo-fu says:

    The “absolutist stance” is towards the practitioners and purveyors and sCAMs, not the consumers.

    Sometimes, that distinction isn’t as clear as it could be.

    In fact, I have argued myself that the reason we here and as physicians need to have more of an absolutist stance is precisely because of the large subset of the population of CAM users that aren’t magical thinkers but are essentially suckered into it by thinking there is some sort of scientific basis for the supplement/treatment they are taking.

    SBM is an educational tool. When teaching, it helps not to insult the student if you want them to see your point of view. For example, you may lose students when you exclaim how they were suckered, but if you show how they were misled, that creates a less judgmental context, and you can get your point across more easily.

    I agree with the goal, to explore the science, or lack thereof, behind these medical claims. I just don’t understand why there seems to be so little discussion of possible benefits via stress reduction and/or physical therapy. It would help to demystify some of these techniques and perhaps allow patients a more grounded perspective.

  47. nybgrus says:

    Sometimes, that distinction isn’t as clear as it could be.

    Short of changing the header of the blog to read:

    “Science-Based Medicine
    Exploring issues and controversies in the relationship between science and medicine, whilst being absolutist only to purveyors of pseudoscience and not patients and consumer”

    I don’t see how it could be more clear and distinct. The issue being that it is woven into the framework of the blog as a whole. So unless each and every blogpost is prefaced with said caveat, someone new to the blog can easily miss that.

    Of course, everyone also has a different personality and style. And quite frankly I think everything from vitriol to Mr. Rogers-esque niceness is necessary and useful, so to try and funnel everything into one form or another is something I would be against.

    When teaching, it helps not to insult the student if you want them to see your point of view. For example, you may lose students when you exclaim how they were suckered, but if you show how they were misled, that creates a less judgmental context, and you can get your point across more easily.

    True indeed. But I think you will find that indeed the attitudes, commentary, writing styles, and topics are quite well balanced here to cover all angles. Sometimes a sucker needs to be called a sucker. Many times here they aren’t. As I said above, all tacks are useful in some regard or another.

    I just don’t understand why there seems to be so little discussion of possible benefits via stress reduction and/or physical therapy.

    IMO, that is because those are mundane and obvious. There aren’t “possible” benefits – there are known and exploited benefits. Now you seem to be interested in a content change, which is fine, but if you want more written on a specific topic you can find a blog to fit your needs. But really, it is also regularly acknowledged here that stress reduction, exercise, diet, etc are indeed science based modalities that are quite helpful and useful. Just look up anything here that has “bait and switch” as the topic.

  48. TILIS you get that you are on a blog, right? That the article that you think is wordy, is a main feature of the blog. You get that the commentor you were addressing, Harriet Hall, is one of the editor/contributors of this blog? For her to mention an upcoming article is plugging the blog that you are reading.

    Are you trying to accuse HH of spamming the blog that she is a contributor to?

    Funny.

  49. woo-fu says:

    @nybgrus

    In the prior response you indicate that no one on this entire blog is belittling the patient in any way, that all the barbs are directed at the purveyors of SCAM. However, I have seen remarks from posts and other comments over past couple of years (No, I’m not a nube here.) that do directly and indirectly insult both.

    You mention Ben Kavoussi, who I have enjoyed reading, except when he takes pot shots at entire groups of people who he feels are responsible for allowing this magical thinking to become an epidemic. It’s not just the alternative practitioners he blames; he goes way beyond the individual to indict entire religious groups and anything he finds remotely “new agey.” Perhaps you should check out his last post, if you haven’t already.

    I suppose this disagreement is pointless since you go on in your next comment to explain why everyone has a different writing style. I suppose insults are simply a matter of taste? Whatever the case, it doesn’t help to get on an emotional high horse, skewer a bunch of folk with your lance and then expect them to want to learn anything from you or your sources.

    On the second major issue, the discussion of stress-reduction benefits and physical therapy benefits, I believe there is some confusion about my point. Of course I have seen posts and comments discuss these topics as they apply to SBM, but there is not much discussion about how some of these alternative techniques might just have the same sorts of benefits. Instead you call it all SCAM.

    In the case where such possible* benefits are discussed, it gets called bait-and-switch when discussing alt techniques; however, that only applies where a consumer expects one product/service and receives something else entirely. It is unfortunate that some egomaniacal individuals make grandiose claims about their product or service. And it is only right and proper to call them out.

    What’s being ignored, it seems, is that many practitioners do not make such claims about their practice. Some will only acknowledge that it can be good exercise, if a physician thinks a person can handle it, and can help establish mental focus and discipline as long as a person doesn’t take it too far.

    Physical therapists make use of Tai Chi movements, Yoga exercises and breathing techniques because they’ve found them to be helpful. Psychiatrists and psychologists also advocate meditation, visualization and breathing techniques, the very same techniques being called SCAM. My point is that there may well be value in alternative techniques if you consider these factors.

    (*I used the term “possible” because not everyone receives these benefits through practice, so I don’t assume they are “known and exploited” for everyone.)

    As to your final point:

    Now you seem to be interested in a content change, which is fine, but if you want more written on a specific topic you can find a blog to fit your needs.

    Your assumption is invalid. I see no reason for a content change. I have a deep respect for science. I also appreciate the breakdown of scientific studies I find here on SBM and the countering of cure-all claims. This is a good resource, and I think it could grow into a great one–one that I could recommend to younger readers–if the emotional rhetoric were turned down and the facts be left to make valid arguments.

    I also happen to have a deep respect for people and know from experience that it is a waste of time to hope to reach people if one does not take steps to understand them first. Disrespect does little to advance one’s point of view; although, I can see why it would be difficult to even feign respect for those self-appointed, self-annointed practitioners who deem their way is the best way for everyone in every circumstance. That, IMO, is a real SCAM.

  50. nybgrus says:

    @woo-fu: I apologize for the brevity, but I just don’t have much time right now.

    I think you are correct that my distinction was not entirely accurate or clear. Belittling the individual person is different from the group. I have no problem making a claim about Christians as a group, for example. But when presented with an individual Christian, I will temper my attitude since I know that each person is different. If the individual lives up to my generalization (stereotype, if you want to use the pejorative) then I will continue my rhetoric in kind. If not, then I will adjust. The point being, is that Ben can rightfully so claim that entire groups espouse and engender magical thinking – because they do. And I don’t think there is anything wrong with that at all. However, I don’t think the authors here get on emotional high horses and skewer the individual or even the masses as much as you claim. However, once again, I see nothing wrong with that at all. This blog is not addressed to a specific person, so calling entire groups wrong in their thinking is often merely a statement of fact. As Dr. Novella once said (paraphrase), it is fine to be culturally sensitive but it has gone too far to the point where we can’t ridicule stupid ideas and tell people they are plainly wrong.

    Your commentary about the “bait and switch” – that IS the bait and switch. We here do not call meditation, yoga, etc sCAM. We say that sCAM co-opts it, proferring science validated modalities such as those, and then inserts their own garbage as the switch.

    My point is that there may well be value in alternative techniques if you consider these factors.

    My point is that they are not alternative. We do not call them sCAM and eschew them – we use them regularly in science based practice. What we call sCAM is when the actual sCAMsters use those same techniques and extend them beyond their scope or couch them in metaphysical nonsense. Yoga is great exercise – but it is not transcendental or metaphysical in any sense.

    I also happen to have a deep respect for people and know from experience that it is a waste of time to hope to reach people if one does not take steps to understand them first.

    Once again, that is a valid assessment on an individual level. If I want to convice a specific person of something, then I will lead with their values first, imbue the science, give some of my own stance, and let them make the decision themselves. But as I said, this blog (really any blog) is not intended for specific individual consumption. This blog is a good source of fact and analysis, even if that means pointing out that other thoughts and groups (and occasionally specific people) are flat out wrong. There is nothing wrong with this blog making the claim that a certain way of thinking is simply wrong. That that may offend some is simply an unavoidable by product. Otherwise you would end up with a wishy-washy blog that can’t really take a stance on something and end up being worthless.

    Once again, I apologize that this is not a polished response, which you deserve, but I really have to get running!

  51. woo-fu says:

    @nybgrus–no worries, your points come across well enough. If I’ve misunderstood anything, I’ll trust the corrections will come. :)

    If the individual lives up to my generalization (stereotype, if you want to use the pejorative) then I will continue my rhetoric in kind. If not, then I will adjust. The point being, is that Ben can rightfully so claim that entire groups espouse and engender magical thinking – because they do…calling entire groups wrong in their thinking is often merely a statement of fact.

    Perhaps, however this same line of thinking has often been the very root of racism–not that I’m in any way implying that you’re promoting racism. I would not make such a gross assumption, especially since you seem very sincere in discussing these points with me.

    Although, I have heard more than a few individuals state, with slight variations, “I hate (insert race here), but the mailman’s OK.” Racism is still very much alive where I live and often takes the form of generalized culture-bashing with minor exceptions for people they know and accept, so I may well be hypersensitive to this issue.

    Singling out particular religious groups for the epidemic of magical thinking assumes a great deal regarding the beliefs of the individuals and across these groups in general. When I asked Ben Kavoussi if he felt ALL practitioners–the individuals–were to blame, I never received a response.

    The belief systems of some of the groups he mentions are actually quite variable and often more sophisticated than the watered-down versions and literalist ideologies he presents them as having. I’m not saying that there aren’t groups which fit in perfectly with his assumptions, for, sadly there are, but to apply that to all groups is simply unfair and unscientific.

    I really don’t mean to pick on Ben Kavoussi in general. And I apologize if I’ve only managed to be a thorn in his side. I believe he has much to offer, and I’ve found thought-provoking material in his posts. Still, I feel that he makes sweeping generalities when it comes to culture at times, and this makes it more difficult to stay focused on the topic at hand and to appreciate his more logical points.

    We here do not call meditation, yoga, etc sCAM. We say that sCAM co-opts it, proferring science validated modalities such as those, and then inserts their own garbage as the switch. My point is that they are not alternative. We do not call them sCAM and eschew them – we use them regularly in science based practice.

    Well, visualization was on Ben’s zombie list of woo making a comeback. Sometimes it is difficult for me to tell what is or is not considered SCAM here. Perhaps you’re right. Maybe I haven’t been reading here long enough to appreciate stylistic differences, but this should be a vehicle for reaching out, not just rallying the fan base.

    I see where you’re coming from–at least I think I do. There are groups that have co-opted the language of science, but not the logic, to boost their appeal. However, some of these techniques go back for centuries, so I don’t think they co-opted any benefits from science-based therapies. Whatever stress-reducing and physical benefits they provide were already there. Although, I will absolutely concede that many, mostly modern, adaptations of these traditions do co-opt the language of science and do misuse it to try and “prove” their path is either backed by science or way ahead of it.

    Phew–I sure hope we’re closer to the same page now. Thanks for taking my concerns seriously enough to address them. Most of the time, I hope, when I make an objection to something posted on SBM it is in the interest of furthering science education, not to simply pick on the writers or to make excuses for real SCAMs.

  52. nybgrus says:

    @woo-fu:

    Thanks for being willing to try and read for understanding my points – I had to run as I was about to be late and today is my day for hospital rounds (something I REFUSE to be late for).

    I’ll start off by saying I think we are a bit closer, and of course I am happy to take your concerns seriously. You actually come across as someone with a genuinely thought out position and some intellectual honesty. You could prove me wrong on that, but I’ve been doing this internet blog/science/comment debate thing enough that I’ve become pretty good at spotting such rhetoric.

    Your concerns are valid. Especially your commentary on racism. I don’t want to write another 20 pages right now so I’ll try and be brief, but essentially, just because stereotyping and group attribution can and has been used in racism, doesn’t mean that is the only thing that it can be used for. In medicine we are regularly engaged in “profiling.” A patient comes in with right lower quadrant abdominal pain – what is your most likely diagnosis? Well, if the person is young, appendicitis, old – diverticulitis. A patient comes in with difficulty breathing and a bunch of dense lesions on their chest xray – what’s the most likely diagnosis? TB if in a 3rd world country, aspiration pneumonia if an indigent/alcoholic, sarcoidosis if a middle aged black woman, etc etc. I think you get the point.

    My examples of religion would get us into another massive discussion, but I’ll perhaps help by saying that it isn’t just a specific religion it is ALL religions. They engender magical thinking and faith based approach to knowledge (vs evidence). So when I say what I did (and you quoted) what I mean is that I actually have very good reason to assume a certain thought pattern, way of thinking, and a few values/ideals/notions a theist may have. Someone can prove me wrong individually. Of course, this does fit in with your commentary on racism and could indeed be dangerous. The only thing I can say here is that once again, sometimes the stereotypes are actually valid, and that when I (personally) do say such things it is not without cause. To me, there is a big difference between saying “all black people are lazy” vs “all theists value faith and magical thinking.” The latter is actually a demonstrable fact of the way in which the majority of that group actually learn and interact. Even those that are “moderate” are only so because they haven’t actually thought it through and thus can still be accurately said to perpetuate and propagate the magical thinking. But now I am channeling Sam Harris.

    Well, visualization was on Ben’s zombie list of woo making a comeback.

    Well, without doing a lit review and really getting into it, quite simply Ben could be wrong. Or he might be right. The point is that we here on this blog (authors included) aren’t perfect. If you think Ben was wrong about that specific point and showed him some evidence I’d bet my stethoscope he’d change his view on it. But I think that doesn’t really change the overall message and tone of his posts, even if he were wrong on that point (or other minor ones – especially for such modalities as visualization that don’t yet have a robust evidence base one way or another).

    You say this should be a vehicle for reaching out, not just rallying a fan base. I agree, but I also think this blog has been very effective in that. I have long said here (and elsewhere) that having robust and dissenting/debunking information available is the most important thing. Sometimes people search for something and find nothing but the pseudoscientific garbage out there – this blog offers a place to find something more robust. Also, I don’t ever think I will acually change the mind of someone with whom I am arguing/debating – but those on the sidelines may watch the debate and get a feel for both sides of the argument giving them a better informed opinion on the matter. And the blog is getting more recognition – Dr. Novella was on the Dr. Oz show, after all.

    I guess what I am saying is that I think this blog actually does do a good job of reaching out and offering an uncompromising stance on the science. It exposes all the ways that sCAMsters try and sound sciencey, it gives explanations, and it demonstrates the science in ways that a lay person can understand. But there is that old adage – you can bring a horse to water but you can’t make it drink.

    Could we do a better job? Sure we always can, and I think the blog has evolved to be better and better. Do we turn some people off and away? Yeah, but that will always happen. But I think another thing this blog does well is demonstrate the need for calling stupid ideas stupid to be OK.

    I had a professor once, in molecular pharmacology. Everyone thought she was a hard ass and a bitch… because she told people they were wrong. This one poor kid in class kept raising his hand and giving the wrong answer. She just flat out said he was wrong. He’d try and argue and she would say nope. Then finally, after literally the 4th or 5th time giving the same wrong answer to different questions, she said he better actually start thinking instead of just tossing out the same answer hoping it will stick sometime. He was pissed, but he learned a valuable lesson. The reality is that kids (and young adults… and adults) get coddled too much and people are afraid to say they are wrong. “Everyone deserves a ribbon!” Well, that breeds bad thinking and bad science. I am all for offending the sensibilities of people like that because I think it is necessary. Not to the point of denigration or utter humiliation, of course. But a very good skill to learn is how to take being told you are wrong… like a boss ;-)

    OK… one last anecdote. I used to work in an ER that was a top level 1 trauma facility (won the Codman award twice during my tenure there). One of our nurses (who really was stupid) managed to get her PhD. Along the way she made this poster about our sepsis protocols. I looked at it and was baffled. She had graphs on there with no labels on the axes – it was literally 3 lines. I had no idea what it was describing. She had the same information listed in two sections… with no explanation as to the significance. The conclusion was “our protocols are good” but there was literally nothing on the poster to support that. It was, pure and simple, garbage that I could have done a better job putting together in middle school. One of the ER docs commented on how terrible it was. He was scolded and told that she put a lot of work into it and it looked pretty. He said, “So what? it doesn’t actually say anything!” and he was sternly told he could not belittle someone like that and her hard work should be respected. This (really stupid) nurse got her PhD and never knew how to properly label a graph.

    That is one isolated example – I’ve many more in my experience. But, the point is that I believe what you are saying is belittling or degrading is, IMO, just proper criticism that people are now much too sensitive to.

    So much for not writing 20 pages! Sorry woo-fu!

    BTW, I may not respond much or fully since I may be off on a last minute weekend getaway to the coast. My lovely girlfriend is itching to get out of the house and have an adventure, so I may “have” to oblige :-)

  53. woo-fu says:

    @nybgrus

    I do see your point about the need to generalize or profile at least some of the time, especially as you’ve presented it medically. I also see the need to question it when it seems to be prejudicial or leads one away from the important points of an argument. This is especially true when younger readers are present.

    Not everyone who reads this blog is an adult or even in high-school. Imagine what a challenge it could be for a public middle school teacher who would like his/her students to be able to use SBM as a resource.

    In public schools, K-12, teachers must show respect for students’ different cultural backgrounds, even if they don’t agree with them. And a science teacher needs to be able to bypass assaults on/from the students’ culture while still getting the students to focus on the science. That doesn’t mean coddling them, but it does mean stopping emotional distractions from preventing learning.

    For example, if a teacher is discussing dinosaurs and their place in earth history and students object because they only believe in creationism, rather than taking on the entire debate about religion (which does not belong in the classroom–unless it is a religion class) a teacher would do better saying, “You may believe in creationism, but you must still be able to explain scientific theories on geologic time, even if you don’t believe them.”

    This avoids the sticky religion argument entirely and refocuses students on learning science. Later on their cognitive dissonance may give way to new beliefs and an appreciation of science. But this rarely happens when students feel personally slighted.

    Yes, I agree that people, myself included, are too sensitive to criticism at times, but it is constructive criticism that is emphasized in the K-12 system. And if a teacher rattled off some of the criticisms seen on this blog in a classroom, parents would be furious, and it would be the teacher who gets sent to the principal’s office.

    Perhaps I’m demanding too much from this blog. The language does seem directed to secondary students and above. Maybe I’m wrong to think it should be used for younger students. Has anyone thought of creating a version which could be more directed to younger audiences?

    I hope folk here at SBM can at least see where I’m coming from regarding my comments on culture, language and science education. I know I’ve managed to offend more than a couple of writers, so hopefully they will see this and understand. I’m not here to troll.

    (on to the religion part)

    Although I am impressed with Sam Harris in many ways and agree with him on many points, I disagree with his assertion regarding participation in a religious group as adding to magical thinking in general. I think many participants are more than willing to share their logical thinking with other members, to call out other members when they sense foolishness and to help educate.

    Some don’t need to believe in anything at all but still may enjoy good company. These individuals may be outliers and may not even be considered theists by his definition, so I’m not sure how much they’re taken into account regarding his position. Furthermore, many religiously-inspired individuals have made significant contributions to math and science, so it seems a little contradictory to imply they’re only adding to the tide of woo.

    Thanks again for the thought-provoking challenges you’ve provided me! Obviously we may not agree on every point, but I can tell one thing for certain. We both love science and want to see much more of an emphasis on critical thinking in general.

    Have a wonderful time on your trip!

    I’ll be busy trying to find Dr. Novella’s appearance on Dr. Oz’s show. I’d like to see that. (I loved the Harris/Chopra debate!)

  54. nybgrus says:

    @woo-fu:

    In short, yeah – I don’t think this blog really is geared for K-12. Perhaps maybe 11-12 at the earliest.

    But I also disagree with your thoughts on a creationist student:

    “You may believe in creationism, but you must still be able to explain scientific theories on geologic time, even if you don’t believe them.”

    I understand where you are coming from. But I think that sort of accomodationism is exactly what the problem is. Teachers are actually afraid to teach evolution in school because of the likelihood of backlash. In my mind, that is different from terrorism only in degree – the truth and education are held dostage because of ignorant outcries of ideology. I honestly think that students could and should be told they are wrong to believe in creationism, without the necessity of entering a religious debate. A simple, “Evolution is definitively the correct explanation for the diversity of life on earth” should suffice. If that leads to an outcry from the parents and the teacher is “sent to the principles office” then so be it – but we mustn’t give in and sacrifice science at the altar of ideology. That is exactly what is happening right now, leading to laws like those in Louisiana and Tennessee. If fixing that means pissing people off, then that is what needs to be done. Religion (and its anti-scientific stance) has gained so much ground because of the cultural taboo against openly critiquing and ridiculing it (which also ties in neatly with “other ways of knowing” and CAM). I say that taboo should be done away with. You can have crazy and wrong ideas, but if you want to claim they are right, you are opening yourself up to inspection and potential ridicule from the likes of me.

    This avoids the sticky religion argument entirely and refocuses students on learning science

    We have been avoiding the “sticky religious argument” for a very long time. And something on the order of 70+% of Americans don’t “believe” in evolution. Refocusing on the science, as you say, has failed. Just look at the Miss USA responses to whether evolution should be taught in schools. Out of 51 contestants, only 2 said yes.

    Later on their cognitive dissonance may give way to new beliefs and an appreciation of science

    I would direct you to the story of Kurt Wise (google it) to see how ineffective that tack really is.

    Yes, I agree that people, myself included, are too sensitive to criticism at times, but it is constructive criticism that is emphasized in the K-12 system.

    Constructive criticism, absolutely. But that also includes telling people they are wrong, when they are wrong. Not skirting the issue. Besides what I’ve already mentioned, it instills in people a dire aversion to being told they are wrong. My sister once told me something I liked very much: “An expert is someone who has failed the most times in a narrow field.” Being able to be told you are wrong, and learning from it instead of having an emotional reaction, is a skill one must learn. Something that is not only not taught to most children these days, but is actively being reinforced as being very wrong. Hence my “Everyone deserves a blue ribbon” comment.

    And if a teacher rattled off some of the criticisms seen on this blog in a classroom, parents would be furious, and it would be the teacher who gets sent to the principal’s office.

    That would be great. Because everything said on this blog can be backed up with evidence and would be an excellent demonstration of critical thinking and the scientific method. Avoiding conflict only gives the anti-science crowd power (hence why I refer to them as terrorists, in a sense – we are too afraid to anger them so we cede to their unreasonable demands).

    Has anyone thought of creating a version which could be more directed to younger audiences?

    That is not a bad idea, but not really something feasible for these topics or authors. Honestly the content here is simply above an elementary level, and beyond most high school level as well. There are plenty of great science and critical thinking books geared for children out there though – I’ve bought some for my nephew.

    Although I am impressed with Sam Harris in many ways and agree with him on many points, I disagree with his assertion regarding participation in a religious group as adding to magical thinking in general.

    There was a time I agreed with you. I cannot anymore. Rather than write out the entirety of the argument (it really is long and complex) I’ll link you to a related conversation I had on reddit with someone discussing the notion. (link – do note though, that it has NSFW language).

    I think many participants are more than willing to share their logical thinking with other members, to call out other members when they sense foolishness and to help educate.

    I simply have to disagree with you here. The laws passed in Tennessee and Louisiana, the pride with which our political leaders deny evolution, and many other facts demonstrate to me that the number of such theists is too small to actually matter. I hope you will accept that I honestly have done the research, reading, and had the experience necessary to make such a claim since I haven’t the time or wherewithal to write it all up.

    Furthermore, many religiously-inspired individuals have made significant contributions to math and science, so it seems a little contradictory to imply they’re only adding to the tide of woo.

    I never said that wasn’t the case. And if my rhetoric came across as me saying that the only thing theists do is inspire magical thinking I apologize. But on the whole, that is the majority of what religion does. The genuine contributions in science by devout theists is always in fields that do not contradict with their dogma. Direct contradiction of said dogma leads to Kurt Wise. I do agree with Harris that science and religion are antithetical to each other – the notion of non-overlapping magisteria is a failed attempt at reconciliation. So it is not contradictory, unless you are bound by “all or nothing” thinking. That is a dangerous trap that theists and sCAMsters regularly fall into, and easy enough not to realize yourself.

    Thanks again for the thought-provoking challenges you’ve provided me! Obviously we may not agree on every point, but I can tell one thing for certain. We both love science and want to see much more of an emphasis on critical thinking in general.

    You are welcome and I thank you in kind. I love intelligent and conscientious disagreement. I think it clearly shows through in my tone, if you decide to read through some of my posts on this blog (I really have no idea how many but easily over 1,000 comments). When you are a dyed in the wool troll or denialist I do not take the collegial attitude I have shown you (and you in kind to me). There is nothing wrong with disagreement – how it is handled is important. And as I said, you clearly seem willing to actually change your mind, should the evidence lead you that way. Hopefully over time and some more comments we can flesh that out some more.

    Have a wonderful time on your trip!

    Thanks! We finally cemented the details and it looks like it will indeed be a fun and much needed getaway!

    As for the Novella on Oz – just youtube it. There is a HQ version of it up for some time. Try and pick up on the various tactics and logical fallacies that Oz uses in response to Novella’s reasoned statements.

  55. nybgrus says:

    ah crap! my HTML got screwed up. The one giant link is correct as the first link re: Miss USA. The second is this link to the NSFW language version of my debate on reddit.

  56. nybgrus says:

    Oh and just to save you the time, here is the link to the correct Kurt Wise to get you started.

  57. woo-fu says:

    @nybgrus

    Wait! I’m not giving the teacher an out on the topics of evolution; etc., they still need to be taught. Sometimes, with the right class, you do have the liberty to launch into such debates; the older the class the easier it is to do.

    However, K-12 science teachers don’t have the authority to dictate to children how they should view their religious beliefs, only to educate them about the scientific method, the history of science and the prevailing theories specific to the “standards of learning” assigned to that grade level. Now a clever teacher can use the “history of science” to introduce the great scientific controversies, but he/she cannot dictate what students will ultimately believe, only what science has revealed.

    I wasn’t implying these discussions not take place, but when a middle school class is halfway through a dinosaur introduction and the teacher needs to get certain information across in that lesson, I don’t see the objection to deferring the debate for a more appropriate time or grade level.

    And I still have at least one major issue in debating evolution v. creationism, as the latter is not a science, and I can’t see an effective manner for comparison other than to say “not proven” or “not provable.” That would also end the discussion rather quickly–maybe that’s a better approach than my first suggestion.

    Thanks for the links; I will check them out. :)

  58. nybgrus says:

    @woo-fu: Ok last post. I swear. We leave for the B&B in 90 minutes.

    However, K-12 science teachers don’t have the authority to dictate to children how they should view their religious beliefs, only to educate them about the scientific method, the history of science and the prevailing theories specific to the “standards of learning” assigned to that grade level.

    I never said they did. But they do have the authority to dictate to children when a scientific theory is undeniably and facually correct. If that happens to clash with their beliefs, that is not the teacher’s fault. If they INSIST – the teacher, IMO, does have the authority to insist back that the science stands.

    Can you imagine having the same debate about math? A student says, “In my religion 2+2=5.” Would the appropriate response be, “You may believe in [special math], but you must still be able to explain scientific theories [and apply math], even if you don’t believe [it].” I think not. And yes, the basics of evolution as should be taught to K-12 students are as set and robust as the notion that 2+2=4.

    That is what I mean about the “cultural sensitivity” being taken too far. Even you are unwilling to tell someone they are flat out wrong in order to tip-toe around their silly beliefs.

    I once commented to a classmate of mine (who herself is a very observant Muslim) that an Australian senator was a young earth creationist. Her response (mind you she is in medical school with me and a bright girl!) was, “Well, everyone is entitle to their beliefs NYBGRUS.” I reckon most people would have left it at that and moved on. I said, “Sure. But they are not entitled to their own facts. The earth is not 6000 years old. Period. And someone in political power should be more educated than that.” She started to rebut…. but realized I was right. We are still friends mind you, but under no circumstance am I willing to back down when someone tries to tell me 2+2=5 or that it is OK to think so.

    I look forward to continued discussion with you!

  59. woo-fu says:

    @nybgrus (& a compliment midway @ Dr. Novella)

    This is slightly disorganized. Hopefully you can see I actually agree with you, but I’m in a Benedryl haze and haven’t had enough caffeine. Enjoy your weekend and thanks for the brain buzz.

    But they [teachers] do have the authority to dictate to children when a scientific theory is undeniably and facually correct. If that happens to clash with their beliefs, that is not the teacher’s fault. If they INSIST – the teacher, IMO, does have the authority to insist back that the science stands.

    And I absolutely agree. Either I didn’t express myself well enough before, or you are misunderstanding my stance.

    The reply gets a tad odd below because I wrote the bottom part first, probably because the next is the quote that got my goat. A bit silly after the first part, but it does have some ideas for teachers to use in order to grab hold of educational opportunities.

    To the mods–apologies for taking this OT.

    That is what I mean about the “cultural sensitivity” being taken too far. Even you are unwilling to tell someone they are flat out wrong in order to tip-toe around their silly beliefs.

    Wrong–I’ll say it now, easily. This is in no way comparing math and math, it is comparing science theory with religion. I have yet to see a presentation which allows for any real comparison. Anyway, I don’t believe I’m in any position to judge what did or did not happen before our universe burst into being, nor do I believe is anyone else.

    Now, on the other hand, if students were to assert that creationism were a scientific theory, then it would be debate time. It would be time to review all those wonderful aspects of the scientific method and what goes in to the creation of scientific theory and laws. Of course, this should be happening in every science class on a more regular basis–people do seem to forget.

    What was I saying?

    If the debate lurches into the direction of timelines, a teacher could discuss methods of time measurement and what archaeology and astronomy have to say about it.

    If a student wants to debate specific religious activities from their cultural stories, that’s generally considered out of the science teacher’s jurisdiction, unless maybe they’re talking about the mechanics of water. Otherwise, their concerns would be better served through a good study of comparative history and world mythology.

    ——————
    I finally got to check out Dr. Novella on Dr. Oz’s show. I’m glad I had to watch Dr. Novella’s calm brilliance as he seemed tag-teamed by both host and guest. They didn’t seem all that interested in allowing Dr. Novella to answer fully, when they gave him a chance at all.

    The view screen behind them was obviously slanted–what is your doctor afraid of? I’m pretty sure this happened more than once, but one incident really stood out where Oz made an assertion right before the break, not allowing Novella to answer at all.

    And yes–I had a hard time keeping up with the number of logical fallacies presented by Dr. Oz and those stupid backdrops! I’ve already forgotten the name of the guest but she seemed to be there just to rubber stamp Dr. Oz’s position.

    I wonder what the ratio of speaking time allowed was? I certainly didn’t get to hear enough of Dr. Novella. But the little I heard straightened me out on a few of his positions and the intent behind this blog. I did not hear one statement that I objected to from Dr. Novella, nor did I hear him use anything other than logic and science to make his point. I was impressed to say the least.
    ———

    Finally, I did check out your link. I may not agree with everything you say, but I do agree with quite a bit and completely understand your need to raise the concerns you do. They are legitimate.

    Not professing a faith or professing the wrong faith does keep people from having a fair chance to win the highest positions in government, and that’s just wrong. I don’t believe in governing from the pulpit, and yet that’s what has been going on for a very long time.

    I also don’t believe in doctoring from the pulpit either, but over the past decade I have seen religious bias increasing its attempts to control medicine. (And I really don’t want to see us fall back upon the days when only monks could be doctors–I’ve seen those pictures–they’re scary.)

    ————-

    At the end of this rambling comment let me just add that I have a better understanding of you and find more to agree with than not. Furthermore, I have a better understanding of this blog, its writers and the passion that comes from urgency. That’s a big win for me!

  60. woo-fu says:

    I’m glad I had to watch Dr. Novella’s calm brilliance…

    should be I’m glad I had the chance to watch Dr. Novella’s calm brilliance…

    Chances are there are plenty more typos in my last comment, but this one jumped out as particularly odd-sounding.

  61. woo-fu says:

    @Mark Crislip

    Getting back to your original topic:

    I must admit to great irritation when the hard work of the ICU team pulls someones bacon out of the fire and the credit goes to god.

    After a team has exhausted themselves trying to save a patient, it must be downright demoralizing to hear that. Sadly, with some of these patients, the only time the medical team gets credit, or rather blame, is when things go wrong. A more appreciative believer could have at least thanked his/her god for bringing them to such fantastic doctors, but I don’t hear people say that very often.

    Geologists do not become young Earth creationists in droves.

    Thank God! ( Just kidding ;) )

    I hadn’t even heard of Kurt Wise until nybgrus posted a link. I suppose Wise–? can stand a great deal of cognitive dissonance. I was stunned. The problem is way worse than I thought.

    *sigh*

  62. nybgrus says:

    @woo-fu:

    Watch this interview of Dr. Georgia Purdom (PhD in molecular genetics, specialty of cellular and molecular biology) by Micheal Shermer.

    I have watched the full 24 minutes more than once. After your brain explodes, perhaps you’ll have a better appreciation of why I tend to be so…. harsh on the topic from time to time.

  63. woo-fu says:

    @nybgrus

    My brain hasn’t exploded, but I am at a loss for words, so there ya go. I felt like Rick Ross should have come along with Shermer, so he could do an intervention!

    God, I can’t believe it! ;)

    And, yes, I now have a much better appreciation of your position.

  64. nybgrus says:

    Brain exploding, loss of words, ta-may-toe, toe-mah-toe. ;-)

    Thanks for taking the time to look at what I put up – it really is difficult to articulate a position like mine because I formed it over a very long time and after (mentally) consuming a vast smorgasbord of media on it (from both sides – I’ve even read entire books by Dinesh D’Souza and many others).

    But I do thank you for being consientious about it and helping me to temper things a bit. It is easy to get lost in a narrow focus and become more passionate and radicalized than warranted.

    But things like that are why I am all for causing a ruckus in high school biology courses and not just skirting the whole issue. Because then you create a safe bubble where the likes of Kurt Wise and Georgia Purdom (and many others like those at Liberty University with an enrollment of 57 THOUSAND) to exist. I think the time to handle religion with kid gloves is over – it is rude to belittle someone; it is not rude to call ideas/beliefs stupid when they deserve it.

    It sucks though – sometimes I wish I could “un-know” the literally thousands of hours of debates, apologism, etc that I have watched over the last 18 months; return to some state of blissful ignorance. I even called up a dear friend last year, who was well versed in these topics and asked him why bother becoming a physician and educator, if so many were so back asswards. He said, “Because of the ones who aren’t.” That was good enough for me…. but still it frightens me that these are the people that give power and credence to the politicians who share the same ideology pushing legislation on science, healthcare, medicine, research, and civil rights.

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